Liver fungal infections: an overview of the etiology and epidemiology in patients affected or not affected by oncohematologic malignancies

Figures & data

Table 1 Overview of liver fungal infections in different types of patients

Host	Candida	Aspergillus	Other fungi
Oncohematologic patients	Incidence reduced after introduction of primary systemic antifungal prophylaxis. The main risk factor is severe and prolonged neutropenia	Mainly due to disseminated disease. Primary hepatic infection is not very frequent. The strongest risk factor is prolonged neutropenia	Unusual complication among oncohematologic patients. Liver fungal infections due to endemic fungi should be suspected in patients from certain geographic areas
Non-oncohematologic patients	Unusual complication among immunocompetent patients. Biliary tract infections were described mainly in patients with PSC	Unusual complication among immunocompetent patients. Biliary tract infections were described mainly in patients with PSC	Anecdotal cases
Neonates and children	Unusual complication among neonates and children. Mainly in disseminated candidiasis	Anecdotal cases	Anecdotal cases
Liver transplantation	Thrombosis of hepatic artery is the main risk factor. Increased risk in selected patients (high-risk patients)	Thrombosis of hepatic artery is the main risk factor. Increased risk in selected patients (high-risk patients)	Liver fungal infections due to endemic fungi should be suspected in patients from certain geographic areas
HIV patients	Unusual complication among HIV patients	Unusual complication among HIV patients	Endemic mycoses are possible

Abbreviations: HIV, human immunodeficiency virus; PSC, primary sclerosing cholangitis.

Table 2 Summary of findings from studies on HSC in patients with oncohematologic malignancies

Reference	Type of study	Country	Time span	HSC cases	Comments
Anttila et al^Citation10	Retrospective cohort	Finland	1980-1993	38	6.8% cases among 562 adult patients suffering from acute leukemia; death rate equal to 78%
Sallah et al^Citation11	Retrospective cohort	USA	1990-1998	23	Review of HSC cases in patients with acute leukemia; mortality rate equal to 17.4%
Pagano et al^Citation12	Retrospective cohort	Italy	1990-2000	28	Review of HSC cases in patients with different oncohematologic malignancies; fatality rate equal to 15%
Chen et al^Citation14	Retrospective cohort	Taiwan	1995-2002	37	7.4% cases among 500 adult patients suffering from acute leukemia; death rate equal to 18.9%
De Castro et al^Citation7	Retrospective cohort	France	2000-2007	24	Review of HSC cases in patients with different oncohematologic malignancies; fatality rate equal to 46%
Sallah et al^Citation16	Retrospective cohort	USA	1990-1998	23	5.4% cases among 423 patients suffering from acute leukemia

Abbreviation: HSC, hepatosplenic candidiasis.

Table 3 Summary of findings on liver fungal infections in patients who had undergone liver transplantation

Reference	Type of study	Country	Comments
Annunziata et al^Citation51	Case report	USA	Hepatic abscess by Candida glabrata in a 48-year-old man 8 years after OLT
Fortùn et al^Citation52	Case series	Spain	Description of four cases with C. glabrata, one with a frank hepatic abscess, the others with fungal isolation from the bile
Alexander et al^Citation53	Retrospectivecohort	Germany	One case of liver fungal infection by C. glabrata among 28 cases of IFIs post-OLT
Musso et al^Citation55	Case report	Italy	Bilioma related to Candida norvegensis in a 47-year-old man
Mazza et al^Citation56	Case report	France	Liver abscess caused by Aspergillus fumigatus in a woman 3 years after OLT
Vucicevic et al^Citation57	Retrospectivecohort	USA	One case of hepatic coccidioidomycosis out of 391 patients post-OLT
Abboud et al^Citation59	Case report	Brazil	Liver abscess related to mucormycosis in a 23-year-old woman
Davari et al^Citation60	Case series	Iran	Hepatic involvement in two patients out of four with diagnosis of mucormycosis after OLT among 51 liver transplant recipients

Abbreviations: IFI, invasive fungal infection; OLT, orthotopic liver transplantation.

Table 4 Uncommon causative pathogens of liver fungal infections in patients with oncohematologic malignancies

Causative agent	Reference Type of study	Country	Comments
Rhodotorula spp.	Rusthoven et al^Citation23	USA	Patient with acute myelogenous leukemia
	Case report
Trichosporon loubieri	Bhaskaran et al^Citation24	USA	Patient with relapsed B-cell acute lymphoblastic
	Case report		leukemia after an allogeneic HSCT
Geotrichum capitatum	Amft et al^Citation25	Italy	Patient with non-Hodgkin’s lymphoma
	Case report
Cryptococcus neoformans	Liu et al^Citation26	Taiwan	Patient with myelodysplastic syndrome and
	Case report		cryptococcal meningoencephalitis
	Suzuki et al^Citation27	Japan	Old patient with HTLV-I
	Case report
Mucormycosis	Khan et al^Citation28	India	Young patient with acute lymphoblastic leukemia on
	Case report		chemotherapy
	Oliver et al^Citation29	USA	Bone marrow transplant recipient in whom hepatic
	Case report		fungal infection developed after ingestion of multiple
			naturopathic medicines
Pneumocystis jirovecii	Cordonnier et al^Citation31	Different nations	Pneumonia is rare in HSCT recipients unless patients
	Fifth European Conference on		do not comply with antifungal prophylaxis
	Infections in Leukemia (ECIL-5)

Abbreviations: HSCT, hematopoietic stem cell transplantation; HTLV, human T-lymphotropic virus.

Table 5 Uncommon causative pathogens of liver fungal infections in patients without oncohematologic malignancies

Causative agent	Reference Type of study	Country	Patient’s underlying condition
Phaeoacremonium parasiticum	Marciano et al^33 Retrospective cohort	USA	Chronic granulomatous disease
Basidiobolomycosis	Hassan et al^42 Retrospective cohort van den Berk et al^43 Case report	Iraq The Netherlands	Biliary tract diseases
	Geramizadeh et al^50 Case report	Iran	Neonates and children
Coccidioides spp.	Vucicevic et al^57 Retrospective cohort	USA	Orthotopic liver transplantation
Mucormycosis	Abboud et al^59 Case report Davari et al^60 Case report	BrazilIran
Cryptococcus neoformans	Cazorla et al^63 Case report	France	Human immunodeficiency virus

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